HIV in pregnancy - An update

Area of Science:

• Infectious Diseases
• Obstetrics & Gynecology
• Public Health

Background:

• Human immunodeficiency virus (HIV) infection poses global health challenges, with no current cure or vaccine.
• Pregnant women with HIV face increased risks of maternal and perinatal morbidity and mortality, especially with uncontrolled viral loads.
• Vertical transmission of HIV from mother to fetus can occur during pregnancy, labor, and postpartum via breastfeeding.

Purpose of the Study:

• To outline essential management strategies for pregnant women living with HIV.
• To emphasize the importance of preconception counseling and optimized viral load for safe pregnancies.
• To detail critical interventions for preventing mother-to-child transmission (MTCT) of HIV.

Main Methods:

• Preconception counseling and planning for pregnancies with minimized viral load.
• Mandatory combined anti-retroviral therapy (cART) during pregnancy with close monitoring of viral load and CD4 counts.
• Careful consideration of delivery management and breastfeeding recommendations based on viral load status.

Main Results:

• Appropriate management, including cART and monitoring, significantly reduces HIV-related risks in pregnancy.
• Delivery planning for women on cART with suppressed viral loads is generally standard.
• Special precautions are needed for late presenters with uncontrolled viral loads to limit vertical transmission.

Conclusions:

• Optimized management of HIV in pregnancy, starting with preconception planning, is crucial for maternal and infant health.
• Continued cART and suppressed viral load are key for safe delivery and reduced breastfeeding transmission risks.
• Specialized care is vital for serodiscordant couples and managing HIV in diverse resource settings.